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NPI Code Detail

MEDICARE: DR. SANDRA M GONZALEZ MD

MEDICARE: DR. SANDRA M GONZALEZ MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080P0204XPediatric Emergency Medicine (Pediatrics) PhysicianME60524FL
2208000000XPediatrics PhysicianME60524FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114251OTHERFLMEDICARE CORE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598750341
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA M GONZALEZ MD
Provider Business Mailing Address
First Line : 10865 SW 153RD AVE
Second Line :
City : MIAMI
State : FL
Zip : 33196-3571
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3100 SW 62ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33155-3009
Country : US
Telephone Number : 305-666-6511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 07/26/2021

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Directions to “ DR. SANDRA M GONZALEZ MD” Practice Location

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